Nationwide accredited low cost state approved dot approved drug testing occupational accident insurance programs for Trucking

Nationwide accredited low cost state approved dot approved drug testing occupational accident insurance programs for Trucking

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Nationwide accredited low cost state approved dot approved drug testing occupational accident insurance programs for Trucking

NorthAmerican
Transportation Association

 Phone: (800) 805-0040
Phone: (562) 279-0557
 Email NTA
2533 Carson St, Suite 346
Carson City, NV 89706

  NEW  DOT/OSHA/HAZMAT SUPER STORE  
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 OWNER OPERATORS  Low Cost - Occupational Accident Insurance Program  More Info

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Coalition Member
 www.ntassoc.com is an Official 2006 Coalition Member

Nationwide accredited low cost state approved dot approved drug testing occupational accident insurance programs for Trucking

 

Truck Insurance - Online Free Quote!
DATE:
*APPLICANT: (Individual Name/Owner)
* EMAIL ADDRESS
* PHONE #:
CELL #:
D/B/A:
GARAGE ADDRESS:
 
Street: City: State: Zip:
(Where you park your trucks)
*COVERAGE NEEDED:
Primary Coverage Liability
  Physical Damage
  Cargo
  OR
Non-Trucking(Bobtail) and Physical Damage
LIABILITY LIMITS:
Amount: Other: MCP/ICC/FHWA Filings:
MC#:
DOT#:
CA#:
OTHER COVERAGES:
Hired Auto:
Non-Owned Trailer:
General Liability:
 
RADIUS: (Furthest Destination)
STATES TRAVELED:
CITIES TRAVELED:
CARGO LIMIT:
Amount: Other: (Keep in mind that most shippers will require a $100,000 limit)
COMMODITIES:
#1:
#2:
#3:
#4:
Commodities: %: Value of Avg. Load: Max value of Load:
(Example: Lumber 45% $30,000 $50,000
YEARS IN BUSINESS:
EXPIRATION DATE:
PRIOR CARRIER INFO:
1st Year:
2nd Year:
3rd Year:
Dates: Insurance Co: Claims/Losses: Amount Paid:
3 YR HISTORY (if you did not have insurance in your name, please indicate
companies that you were leased on, or companies for which you were a driver)
VEHICLE SCHEDULE:
#1:
#2:
#3:
#4:
#5:
#6:
#7:
#8:
#9:
#10
Year: Make/Model: Radius: GVW: Value: Deductible:
 
DRIVER INFO:
#1:
#2:
#3:
#4:
#5:
#6:
#7:
#8:
#9:
#10:
Name: DOB: Yrs w/ CDL: Date of Hire: Violations:  
 
 
 
 
 
 
 
 
 
 
(Try to be as specific as possible when reporting violations! Give dates, and if speeding, give how much over posted limit. We need prior three year history.)
HOW DID YOU FIND US? 
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COMMENTS: 
 

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North American Transportation Association Inc.
Corporate Office
2533 North Carson Street - Suite 346 - Carson City, Nevada 89706

 DOT/OSHA/HAZMAT SUPER STORE
.

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